Skip to main content

Member rights and responsibilities

Understanding your health plan is important. You have rights and responsibilities as a member of Aetna Better Health® of Virginia. Be sure to check the materials and forms page for your member handbook. Inside, you’ll find your full rights and responsibilities.

Materials and forms page

Your rights

  • Be informed of Aetna Better Health and all covered services. 
  • Receive information about Aetna Better Health, our services, doctors, other providers, and member rights and responsibilities. 
  • Be treated with respect, dignity, and the right to privacy. 
  • Choose their personal Aetna Better Health doctor/PCP. 
  • Change their Aetna Better Health PCP. 
  • Be treated regardless of race, gender, religion, disability, ethnicity, national origin, or source of payment. 
  • Expect all information about their health to be confidential and to have their privacy protected. 
  • Not have their medical records shown to others without their approval, unless allowed by law. 
  • Receive information from their doctor about treatment options or other types of care available to members, appropriate to their condition, and explained in a way that members can understand. 
  • Receive services from out-of-network providers. 
  • Receive a second opinion on a medical procedure from an in-plan provider. If an Aetna Better Health provider is not available, we will help members get a second opinion from a non-participating provider at no cost to members. 
  • Participate with their doctor/provider in making decisions about their health care. 
  • Tell the doctor/provider that members do not want treatment and be told what may happen if members do not have the treatment. Members can continue to get Medicaid and medical care without any repercussions even if members say no to treatment. 
  • Make an official complaint or grievance about Aetna Better Health or file an appeal if members are not happy with the answer to their question, complaint/grievance, or care given. 
  • Appeal a medical decision made by Aetna Better Health directly to DMAS. 
  • Know the cost to members if members choose to get a service that Aetna Better Health does not cover. 
  • Be told in writing by Aetna Better Health when any of their health care services requested by their PCP are reduced, suspended, terminated, or denied. Members must follow the instructions in their notification letter. 
  • Have members and/or their child’s doctor/provider tell members about treatment choices members may have, no matter what the cost or benefit coverage. 
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation. 
  • Find out what is in their medical records and request that they be corrected or amended. 
  • Request a copy of their medical records. 
  • Exercise their rights and to know that members will not have any retaliation against members by Aetna Better Health, any of our doctors/providers or state agencies. 
  • Access to health care services and medical advice 24 hours a day, seven days a week, including urgent and emergency services. 
  • Get family planning services from any participating Medicaid provider without prior authorization. 
  • Get information in different formats (i.e., large print, Braille, etc.), at no cost to members, if needed and in an easy form that takes into consideration the special needs of those who may have problems seeing or reading. 
  • Get interpretation services if members do not speak English or have a hearing impairment to help members get the medical services members need. 
  • Make recommendations or suggestions regarding Aetna Better Health’s member rights and responsibilities. 
  • Develop Advance Directives or a Living Will, which tell how to have medical decisions made for members if members are not able to make them for themselves. 
  • Ask for a description of all types of payment arrangements that we use to pay providers for health care services. 
  • Exercise your rights and to know that you will not have any retaliation against you by Aetna Better Health, any of our doctors/providers or state agencies.
  • Receive timely access to care and services. 
  • Take part in decisions about their health care, including their right to choose their providers from Aetna Better Health network providers and their right to refuse treatment. 
  • Choose to receive long-term services and supports in their home or community or in a nursing facility. 
  • Confidentiality and privacy about their medical records and when member gets treatment. 
  • Receive information and to discuss available treatment options and alternatives presented in a manner and language member understands. 
  • Get information in a language member understands; member can get oral translation services free of charge. 
  • Receive reasonable accommodations to ensure member can effectively access and communicate with providers, including auxiliary aids, interpreters, flexible scheduling, and physically accessible buildings and services. 
  • Receive information necessary for member to give informed consent before the start of treatment. 
  • Be treated with respect and dignity. 
  • Get a copy of their medical records and ask that the records be amended or corrected. 
  • Be free from restraint or seclusion unless ordered by a physician when there is an imminent risk of bodily harm to member or others, or when there is a specific medical necessity. Seclusion and restraint will never be used as a means of coercion, discipline, retaliation, or convenience. 
  • Get care without regard to disability, gender, race, health status, color, age, national origin, sexual orientation, marital status, or religion. 
  • Be informed of where, when, and how to obtain the services member need from Aetna Better Health, including how member can receive benefits from out-of-network providers if the services are not available in Aetna Better Health’s network. 
  • Complain about Aetna Better Health to the State. 
  • Appoint someone to speak for member about their care and treatment and to represent member in an appeal. 
  • Make advance directives and plans about their care in the instance that member is not able to make their own health care decisions. See Section 17 of their member handbook for information about Advance Directives. 
  • Change their health plan once a year for any reason during open enrollment or change their MCO after open enrollment for an approved reason. Reference Section 2 of their member handbook. 
  • Appeal any adverse benefit determination (decision) by Aetna Better Health that member disagrees with that relates to coverage or payment of services. 
  • File a complaint about any concerns that member has with our customer service, the services member has received, or the care and treatment member has received from one of our network providers. See Their Right to File a Complaint in Section 15 of their member handbook. 
  • To receive information from us about our plan, their covered services, providers in our network, and about their rights and responsibilities. 
  • To make recommendations regarding our member rights and responsibility policy, for example, by joining our Member Advisory Committee. 
  • Exercise your rights and to know that you will not have any retaliation against you by Aetna Better Health, any of our doctors/providers or state agencies.

Everyone has the right to live a safe life in the home or setting of their choice. Each year, many older adults and younger adults who are disabled are victims of mistreatment by family members, by caregivers and by others responsible for their well-being. If a member is being abused physically, is being neglected, or is being taken advantage of financially by a family member or someone else, a member should call their local department of social services or the Virginia Department of Social Services' 24-hour toll-free hotline at: 888-832-3858. Members can make this call anonymously; they do not have to provide their name and the call is free. 


Trained social workers may be provided to assist and help the member receive the types of services they need to assure that they are safe.

Aetna Better Health will only release information if it is specifically permitted by state and federal law or if it is required for use by programs that review medical records to monitor quality of care or to combat fraud or abuse. 


Aetna Better Health staff will ask questions to confirm the member’s identity before we discuss or provide any information regarding their health information. 


We understand the importance of keeping personal and health information secure and private. Both Aetna Better Health and the member’s doctors make sure that all member records are kept safe and private. We limit access to personal information to those who need it. We maintain safeguards to protect it. For example, we protect access to our buildings and computer systems. Our privacy office also assures the training of our staff on our privacy and security policies. If needed, we may use and share personal information for treatment, payment, and health care operations. We limit the amount of information that we share about members as required by law. For example, HIV/AIDS, substance abuse and genetic information may be further protected by law. Our privacy policies will always reflect the most protective laws that apply.

Your responsibilities 

  • Reading the member handbook. 
  • Scheduling wellness check-ups. Members under 21 years of age need to follow the EPSDT schedule. 
  • Getting care as soon as members know they are pregnant. 
  • Keeping all prenatal appointments. 
  • Carrying and showing Aetna Better Health ID card to each doctor before getting health services. 
  • Protecting member ID card and not sharing it with others. 
  • Getting medical care from providers in our network. 
  • Knowing the name of member’s assigned PCP. 
  • Telling the doctor that the member and/or their child or children is/are a member of Aetna Better Health at the time that they speak with the doctor’s office. 
  • Keeping doctor’s appointments or calling to cancel them at least 24 hours ahead of time. 
  • Using the ER for true emergencies only. 
  • Learning the difference between emergencies and urgent care. 
  • Treating the doctors/providers, staff and people providing services with respect. 
  • Giving all information about member’s health to Aetna Better Health and member’s doctor to provide care.
  • Telling the doctor if member does not understand what they tell member about member’s health so that the member and doctor can make health plans together. 
  • Following what member and doctor agree to do including making follow-up appointments, taking medications, and following the doctor’s care instructions. 
  • Telling Aetna Better Health and DMAS when member’s address changes. 
  • Telling Aetna Better Health about changes in member’s family that might affect member’s eligibility or enrollment such as family size, employment, and moving out of the state of Virginia. 
  • Telling Aetna Better Health if member has other health insurance, including Medicare. 
  • Giving member’s doctor a copy of their Living Will and/or Advance Directive. 
  • Learning about prescription drugs and reasons for taking them. 
  • Letting Aetna Better Health know how we can work better for the member. 


Aetna Better Health distributes its member rights and responsibility statement to new members in enrollment kits and to existing members via newsletter and website access each year. Members can request a copy be mailed to them by contacting Member Services. We also distribute the member rights and responsibility statement to new providers when they join our network and to existing providers each year via the website. 


In addition, Aetna Better Health complies with any other federal and State laws that pertain to member rights including Title VI of the Civil Rights Act of 1964 as implemented by regulations at 45 CFR part 80, the Age Discrimination Act of 1975 as implemented by regulations at 45 CFR part 91, the Rehabilitation Act of 1973, and Titles II and III of the Americans with Disabilities Act; and section 1557 of the Patient Protection and Affordable Care Act. 



We can help

You can call your Member Services department anytime. 

Contact us

You can also check your member handbook for answers. Just visit our materials and forms page.

Also of interest: